Acta med. scand. Vol. 199, pp. 357-361, 1976
Serum Lipids in Alcoholics L. E. Bottiger, L. A. Carlson, E. Hultman and V. Romanus From the King Gustav V Research Institute, and the Department of Medicine, Karolinska Hospital, and the Department of Clinical Chemistry, Beckomberga Hospital, Stockholm, Sweden
ABSTRACT. Fasting serum lipid values (cholesterol, triglycerides and phospholipids) have been analysed in a group of 85 male and 10 female alcoholics of various ages in connection with an acute drinking bout and compared to the values of twice as many control subjects. The most prominent finding was an increase in the mean concentration of triglycerides and phospholipids, most marked in the younger age groups. The elevations, however, were moderate and most alcoholics had the same serum lipid values as the controls. Serum triglyceride values above 2 and 3 mmol/l, respectively, occurred in 23 % and 4 % in controls and in 28 % and 139i in alcoholics. It is suggested that excessive intake of alcohol induces hypertriglyceridaemia only when other factors are present. One such factor may be a reduced i.v. fat tolerance. Hyperlipidaemia of type IV and type V according to the nomenclature of Fredrickson et al. (11) is characterized by elevated levels of serum triglycerides but usually normal concentrations of serum cholesterol, unless there is very marked elevation of triglycerides, when there is also a concomitant rise in cholesterol. The major difference between the more common type IV and type V is the presence in the latter of chylomicrons in fasting serum samples. In Stockholm, hypertriglyceridaemia is common in patients with coronary heart disease ( 5 ) and it is also a “risk factor” for the development of future coronary heart disease (6). Furthermore, apparently healthy men with various forms of hypertriglyceridaemia-hyperlipoproteinaemias types I1 B, 111 and IV according to the WHO nomenclature ( I)-have an increased frequency of ischaemic exercise ECGs (7). Elucidation of the etiology and pathogenesis of hypertriglyceridaemia
is thus an important task considering the high and increasing frequency of coronary heart disease. Several factors have been recognized to be closely associated with hypertriglyceridaemia. Among these are diabetes and glucose intolerance, obesity, dietary carbohydrates, plasma free fatty acids and alcohol. In 1958 Zieve (15) reported the occurrence of hyperlipidaemia, jaundice and mild haemolysis in 20 alcoholics after prolonged periods of heavy drinking. In a survey of 211 consecutive patients seen at Hammersmith Hospital, Chait et al. (10) found that alcohol next to diabetes was the most common cause of secondary hyperlipidaemia, followed by renal diseases. Furthermore, in a recent population study on 202 apparently healthy men (14), the stated frequency of alcohol ingestion was significantly and positively related to serum triglyceride concentration @ 70
26 35 46 54 64 77
9 19 26 16 13 2
220k13.3 223f12.1 235f 9.8 246f 8.3 234f12.7 206f16.0
1.4450.27 2.06f0.34 2.05f0.49 1.78f0.30 1.47f0.27 1.oOfO.04
26 35 46 54 64 71
38 52 32 23 1
221f9.7 236f8.2 248f7.7 277f8.2 257f7.9 258
1.29f0.14 1.29k0.09 I .55+0. I I 2.1 I k0.22 1.39k0.08 1.40
Women 50-78
61
10
280f10.9
1.47f0.29
61
20
305f11.7
1.44k0.13
Age group Men 2 1-30 3 1-40 4 1-50
survey centre in Stockholm (13). These controls have all been subjectively and objectively healthy, they had normal Hb and ESR and no protein or glucose in the urine. All were in active work, but there were no possibilities of excluding an existing “silent” alcoholism-no records were kept regarding alcohol intake.
18
METHODS
Serum cholesterol (2) and triglycerides (12) have been analysed by a semiautomatic method using a Technicon AutoAnalyzer equipment. Serum phospholipids (total lipid P, lecithin and lysolecithin) have been analysed by thin layer chromatography and determination of lipid phosphorus (3). Liver function tests, etc. have all been performed according to hospital standard routine.
Blood samplesdrawn in the fasting state-were obtained from patients on the day after admission, from controls in connection with the yearly visit to the health centre. Serum from controls was separated within 1-2 hours and frozen. Serum from alcoholics was left at room temperature for a somewhat longer time (3-4 hours). Hospital routine chemistry was performed immediately, one portion of serum was frozen. Frozen sera were kept at -20°C until analysed.
The composition of the material with regard to sex and age is seen in Table I. Mean values for serum lipids in various age groups are given in Tables I and 11. Serum cholesterol values were lower in male
RESULTS
Table 11. Serum phospholipid concentration (total lipid P , lecithin and lysolecithin) (pglml) in alcoholics and controls (mean f S . E . M . ) Alcoholics
Age group Men 21-30 31-40 41-50 5140
61-70 Mean %
Controls
n
Total lipid P
LysoLeci- lecithin thin Lysoleci- (% of (% of LecithinP thinP total) total)
9 19 26 15 9
115.1f9.8 117.0f4.6 121.5k4.0 120.3k2.6 114.8f6.2
66.2f2.6 74.3k2.6 76.3f2.0 74.4f3.4 69.7f3.6
Women 50-78 9 129.1k5.2 78.453.6 ~
Acts med. scand. 199
12.7fl.l 13.0f0.6 12.9k0.5 13.5f0.8 12.351.0
n
I
Total IipidP
Lecithin Lysoleci- (% of LecithinP thin P total)
57.5 63.5 62.8 61.8 60.7 61.3
11.0 11.1 10.6 11.2 10.7 10.9
92.5k4.8 54.222.3 10 100.9f6.8 57.4f3.1 10 101.3f3.9 60.0f2.9 10 116.2k7.2 65.Of3.2 10 115.9f5.2 65.9k3.1
10.lf0.6 9.6f0.6 11.3f0.5 11.5f0.7
12.2k0.9 60.7
9.4
10 121.9f4.1 70.4+2.6
10.4k0.4
10
11.8+0.5
Lysolecithin (% of total)
58.6 56.9 59.2 55.9 56.9 57.5
10.9 9.5 11.2 9.9 10.2 10.3
57.8
8.5
Serum lipids in alcoholics %
359
% x--x
alcoholics
o---o
conlrols
x-x
olcaholics
o---o
conlr015
d 7
100
200
SERUM CHOLESTEROL
,
300
0.5
400
t
o
2.0
4.0
SERUM T A I G L Y C E R I D E S
eo
16.0
mmol I I
m g l l O O ml
F i g . 1. Frequency distributionof serum cholesterol values for male alcoholics and controls.
alcoholics than in the controls in all age groups. Statistical difference is found only in the age group 51-60 @
Serum Lipids in Alcoholics L. E. Bottiger, L. A. Carlson, E. Hultman and V. Romanus From the King Gustav V Research Institute, and the Department of Medicine, Karolinska Hospital, and the Department of Clinical Chemistry, Beckomberga Hospital, Stockholm, Sweden
ABSTRACT. Fasting serum lipid values (cholesterol, triglycerides and phospholipids) have been analysed in a group of 85 male and 10 female alcoholics of various ages in connection with an acute drinking bout and compared to the values of twice as many control subjects. The most prominent finding was an increase in the mean concentration of triglycerides and phospholipids, most marked in the younger age groups. The elevations, however, were moderate and most alcoholics had the same serum lipid values as the controls. Serum triglyceride values above 2 and 3 mmol/l, respectively, occurred in 23 % and 4 % in controls and in 28 % and 139i in alcoholics. It is suggested that excessive intake of alcohol induces hypertriglyceridaemia only when other factors are present. One such factor may be a reduced i.v. fat tolerance. Hyperlipidaemia of type IV and type V according to the nomenclature of Fredrickson et al. (11) is characterized by elevated levels of serum triglycerides but usually normal concentrations of serum cholesterol, unless there is very marked elevation of triglycerides, when there is also a concomitant rise in cholesterol. The major difference between the more common type IV and type V is the presence in the latter of chylomicrons in fasting serum samples. In Stockholm, hypertriglyceridaemia is common in patients with coronary heart disease ( 5 ) and it is also a “risk factor” for the development of future coronary heart disease (6). Furthermore, apparently healthy men with various forms of hypertriglyceridaemia-hyperlipoproteinaemias types I1 B, 111 and IV according to the WHO nomenclature ( I)-have an increased frequency of ischaemic exercise ECGs (7). Elucidation of the etiology and pathogenesis of hypertriglyceridaemia
is thus an important task considering the high and increasing frequency of coronary heart disease. Several factors have been recognized to be closely associated with hypertriglyceridaemia. Among these are diabetes and glucose intolerance, obesity, dietary carbohydrates, plasma free fatty acids and alcohol. In 1958 Zieve (15) reported the occurrence of hyperlipidaemia, jaundice and mild haemolysis in 20 alcoholics after prolonged periods of heavy drinking. In a survey of 211 consecutive patients seen at Hammersmith Hospital, Chait et al. (10) found that alcohol next to diabetes was the most common cause of secondary hyperlipidaemia, followed by renal diseases. Furthermore, in a recent population study on 202 apparently healthy men (14), the stated frequency of alcohol ingestion was significantly and positively related to serum triglyceride concentration @ 70
26 35 46 54 64 77
9 19 26 16 13 2
220k13.3 223f12.1 235f 9.8 246f 8.3 234f12.7 206f16.0
1.4450.27 2.06f0.34 2.05f0.49 1.78f0.30 1.47f0.27 1.oOfO.04
26 35 46 54 64 71
38 52 32 23 1
221f9.7 236f8.2 248f7.7 277f8.2 257f7.9 258
1.29f0.14 1.29k0.09 I .55+0. I I 2.1 I k0.22 1.39k0.08 1.40
Women 50-78
61
10
280f10.9
1.47f0.29
61
20
305f11.7
1.44k0.13
Age group Men 2 1-30 3 1-40 4 1-50
survey centre in Stockholm (13). These controls have all been subjectively and objectively healthy, they had normal Hb and ESR and no protein or glucose in the urine. All were in active work, but there were no possibilities of excluding an existing “silent” alcoholism-no records were kept regarding alcohol intake.
18
METHODS
Serum cholesterol (2) and triglycerides (12) have been analysed by a semiautomatic method using a Technicon AutoAnalyzer equipment. Serum phospholipids (total lipid P, lecithin and lysolecithin) have been analysed by thin layer chromatography and determination of lipid phosphorus (3). Liver function tests, etc. have all been performed according to hospital standard routine.
Blood samplesdrawn in the fasting state-were obtained from patients on the day after admission, from controls in connection with the yearly visit to the health centre. Serum from controls was separated within 1-2 hours and frozen. Serum from alcoholics was left at room temperature for a somewhat longer time (3-4 hours). Hospital routine chemistry was performed immediately, one portion of serum was frozen. Frozen sera were kept at -20°C until analysed.
The composition of the material with regard to sex and age is seen in Table I. Mean values for serum lipids in various age groups are given in Tables I and 11. Serum cholesterol values were lower in male
RESULTS
Table 11. Serum phospholipid concentration (total lipid P , lecithin and lysolecithin) (pglml) in alcoholics and controls (mean f S . E . M . ) Alcoholics
Age group Men 21-30 31-40 41-50 5140
61-70 Mean %
Controls
n
Total lipid P
LysoLeci- lecithin thin Lysoleci- (% of (% of LecithinP thinP total) total)
9 19 26 15 9
115.1f9.8 117.0f4.6 121.5k4.0 120.3k2.6 114.8f6.2
66.2f2.6 74.3k2.6 76.3f2.0 74.4f3.4 69.7f3.6
Women 50-78 9 129.1k5.2 78.453.6 ~
Acts med. scand. 199
12.7fl.l 13.0f0.6 12.9k0.5 13.5f0.8 12.351.0
n
I
Total IipidP
Lecithin Lysoleci- (% of LecithinP thin P total)
57.5 63.5 62.8 61.8 60.7 61.3
11.0 11.1 10.6 11.2 10.7 10.9
92.5k4.8 54.222.3 10 100.9f6.8 57.4f3.1 10 101.3f3.9 60.0f2.9 10 116.2k7.2 65.Of3.2 10 115.9f5.2 65.9k3.1
10.lf0.6 9.6f0.6 11.3f0.5 11.5f0.7
12.2k0.9 60.7
9.4
10 121.9f4.1 70.4+2.6
10.4k0.4
10
11.8+0.5
Lysolecithin (% of total)
58.6 56.9 59.2 55.9 56.9 57.5
10.9 9.5 11.2 9.9 10.2 10.3
57.8
8.5
Serum lipids in alcoholics %
359
% x--x
alcoholics
o---o
conlrols
x-x
olcaholics
o---o
conlr015
d 7
100
200
SERUM CHOLESTEROL
,
300
0.5
400
t
o
2.0
4.0
SERUM T A I G L Y C E R I D E S
eo
16.0
mmol I I
m g l l O O ml
F i g . 1. Frequency distributionof serum cholesterol values for male alcoholics and controls.
alcoholics than in the controls in all age groups. Statistical difference is found only in the age group 51-60 @
